MEDICARE: KATHLEEN STUDDERT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	4013701	NY
2	163WP0200X	Pediatric Registered Nurse	4013701	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184891376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN STUDDERT

Provider Business Mailing Address
First Line	:	3632 OVERLOOK AVE
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-1018
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3632 OVERLOOK AVE
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-1018
Country	:	US
Telephone Number	:	914-962-1377
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2008
Last Update Date	:	05/15/2008

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Directions to “ KATHLEEN STUDDERT ” Practice Location

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